Physiotherapists' Experiences of Forensic Audits by South African Medical Funding Schemes

Werdie van Staden, Karien Mostert, Lesley Meyer, Tshegofatso Moatshe
Purpose:

This study aimed to explore and describe the experiences South African private practice physiotherapists had, due to forensic auditing conducted by medical funding schemes.

Methods:

A qualitative study was conducted using a semi-structured open-ended interview guide. Ethical clearance and participant consent was obtained. All interviews were conducted online and automatically recorded and transcribed using the Cisco Webex platform. A total of 14 physiotherapists who had been audited were interviewed. Eleven physiotherapists were interviewed individually while 13 participants attended Focus Group Discussions (FGDs). The FGDs contained five, six, and two participants respectively. Data was analysed using open coding and axial coding where the themes and sub-themes emerged. Saturation was obtained after the first FGD which was subsequently confirmed through analysis of the other interviews and discussions.

Results:

 Six themes emerged from the rich data collected through the interviews.The first five themes captured the adverse experiences of physiotherapists. These were 1) “unfairly persecuted, judged, and penalised”, 2) “overpowered and oppressed”, 3) “naively entrapped between a rock and a hard place”, 4) “distressed with a knife over your head”, and 5) “detrimental and hurtful”. The sixth theme, “seeking remedies pre-emptively and preparedly”, was about the different solutions participants recommended to prevent other physiotherapists from having to go through a negative auditing experience.

Conclusion(s):

Physiotherapists experienced the forensic audits adversely and made recommendations on how these may be averted. Further studies may investigate how these audits may be tailored more constructively in curtailing adverse experiences of physiotherapists. It would be prudent for stakeholders, who have been tasked with protecting the physiotherapy profession, to investigate these findings further. If the findings are corroborated, then solutions need to be implemented. 

Implications:

The presentation of these findings is anticipated to create much interest, providing information that could be referenced by physiotherapists and other medical professionals.

Funding acknowledgements:
No funding was received
Keywords:
Forensic audits
Practice management
Mental health
Primary topic:
Professional issues: business skills, leadership, advocacy and change management
Second topic:
Mental health
Third topic:
Innovative technology: information management, big data and artificial intelligence
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Centre for Ethics and Philosophy of Health Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Provide the ethics approval number:
135/2022
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

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